Evidence-Based OCD Treatment for Long Island Adults, Teens, and Families Living With Obsessions and Compulsions
Obsessive compulsive disorder, or OCD, is a mental health condition that affects thousands of people across Long Island. Obsessive-compulsive disorder has two parts:
- Obsessions – A thought, image, or urge that shows up repeatedly and causes anxiety or distress, and it isn’t something the person wants to be thinking about. Examples include the thought that your hands are still contaminated after you’ve already washed them, the fear that you left the stove on after you’ve already checked it, an intrusive image of harming someone despite having no desire to act on it.
- Compulsions – A behavior or mental act performed in response to the obsession to reduce the distress it causes: washing your hands again, going back to check the stove a second or third time, mentally reviewing the last hour to confirm no harm occurred, or silently repeating a phrase or prayer until it feels right.
We all have the occasional intrusive thought. But when those thoughts and compulsions interfere with your happiness, relationships, or health, it becomes more than just passing thought. It becomes a mental health challenge worth solving.
Nassau Counseling Services treats OCD across Long Island using psychotherapy techniques built around you. We may use approaches that include exposure and response prevention, cognitive therapy, and other mental health approaches to help you find relief from the symptoms. Contact us today at (516) 973-1032 to schedule an initial assessment and go over what a treatment plan would look like for a specific set of symptoms.
Common Types of Obsessions and Compulsions
OCD is different for different people, but a handful of patterns show up consistently in clinical practice:
- Contamination and Washing — Fear of germs, illness, or dirt, addressed through repeated handwashing, showering, or avoiding objects and surfaces perceived as contaminated.
- Checking — Repeatedly checking locks, appliances, or that a task was completed correctly, driven by fear that something bad will happen if the check is skipped. Checking behaviors can also be mental. For example, a person may test themselves to see if they’re interested in the content of their obsession.
- Symmetry and Ordering — A need for objects to be arranged a specific way, or for actions to be repeated until they feel correct, not always tied to a specific feared outcome.
- Harm and Intrusive Thoughts — Unwanted thoughts or images about causing harm to oneself or others, paired with checking or avoidance behaviors meant to prevent that harm, despite no actual desire to act on the thought.
- Scrupulosity — Religious or moral obsessions involving fear of having sinned, lied, or acted immorally, addressed through confession, prayer rituals, or seeking reassurance from religious authorities.
- Relationship-Focused Obsessions — Persistent doubt about whether a relationship is right or whether a partner is loved enough, addressed through reassurance-seeking, comparing the relationship to others, or mentally reviewing interactions for evidence.
These categories respond to the same underlying treatment approaches, even when the specific content of the obsession looks nothing alike from one client to the next.
Treatments and Options for OCD
At Nassau Counseling Services, we provide a caring personalized approach to OCD in a judgement free space, allowing you to talk about your obsessions and behaviors without fear. Examples of some of these approaches include:
Exposure and Response Prevention
Exposure and response prevention, ERP, is the specific technique with the largest evidence base for OCD. A therapist and client build a hierarchy: a list of feared situations ranked from least to most distressing.
Starting with a lower-ranked item, for example touching a doorknob without washing hands afterward, the client stays with the anxiety that follows instead of performing the compulsion. The anxiety rises, then comes down on its own once enough time passes without the ritual. Repeating this across the hierarchy, moving to harder items as easier ones become manageable, is what produces symptom reduction over the course of treatment.
In a randomized clinical trial comparing ERP to stress management training, 78.95 percent of participants who received ERP met criteria for treatment response, compared to 15.79 percent of participants who received stress management training. Among adults in the trial specifically, 83.33 percent responded to ERP and 43.33 percent reached full remission, defined as a Yale-Brown Obsessive Compulsive Scale score of 12 or below combined with a low clinician-rated severity score.
Cognitive Therapy Alongside Exposure Work
ERP is usually paired with cognitive therapy that addresses two thinking patterns that keep OCD active: inflated responsibility, the belief that a person is personally responsible for preventing harm even when the odds of that harm are extremely low, and thought-action fusion, the belief that having a thought about something is nearly as bad as doing it, or that the thought itself makes the feared event more likely.
Working directly on these beliefs alongside the exposure work helps a client understand why the exposures work, and reduces the chance that compulsions reappear in a different form once treatment ends.
Acceptance and Commitment Therapy as an Alternative or Add-On
Acceptance and Commitment Therapy, ACT, is a different approach some clients respond to, particularly when starting ERP feels too difficult or ERP alone hasn’t produced enough improvement.
Instead of working to reduce how often an obsessive thought occurs, ACT works on a client’s relationship to that thought, building the ability to notice an intrusive thought and let it pass without needing to control, neutralize, or argue with it. A systematic review of ACT for OCD found it produced a significant decrease in symptoms compared to wait-list and placebo conditions, with gains maintained at follow-up, though ACT on its own didn’t outperform traditional CBT and ERP. The same review found ACT combined with medication performed comparably to a combination of CBT and medication.
For a client who wants an approach built around changing their relationship to intrusive thoughts rather than direct, repeated confrontation with feared situations, ACT is a reasonable option, often used alongside medication rather than as a complete standalone replacement for ERP.
Family Involvement and Reducing Accommodation
Research on family accommodation in OCD has found that it occurs in 60 to 97 percent of families with a member who has OCD, and that most of those families accommodate daily. Accommodation looks like a parent answering the same reassurance-seeking question several times a day, a partner performing part of a ritual on someone’s behalf because it’s faster than waiting them out, or a family reorganizing its schedule around a person’s compulsions.
Most family members who accommodate don’t believe it helps, according to the same research, yet they do it anyway because it reduces distress in the moment, the same mechanism that keeps a compulsion going for the person with OCD.
When a client wants it, family or partner sessions work on reducing that accommodation gradually, without pulling support away all at once.
What Treatment Involves at Nassau Counseling Services
Treatment planning starts with a detailed conversation about which specific obsessions, compulsions, and family dynamics are present in a given client’s case, since the categories above describe common patterns but rarely describe any one person’s experience exactly. From there, a treatment plan is built around whichever approach or combination of approaches fits:
- Assessment — Mapping the specific obsessions, compulsions, and any family accommodation patterns before building a treatment plan.
- Exposure Hierarchy Development — Ranking feared situations from least to most distressing for clients doing ERP.
- Weekly Sessions — Working through exposures, cognitive restructuring, or ACT-based skills depending on the approach, typically over 12 to 20 sessions for a full course of treatment.
- Family or Partner Sessions — Addressing accommodation patterns directly when a client’s OCD involves a spouse, partner, or family member.
- Relapse Prevention Planning — Preparing for high-stress periods after symptoms improve, since OCD commonly resurfaces under stress without an ongoing plan.
The specific mix of these pieces depends on symptom severity, how long OCD has been present, and whether family members are already involved in a client’s rituals.
Co-Occurring Conditions
OCD frequently occurs alongside other conditions, most often generalized anxiety, panic disorder, and depression. A client already working with an anxiety diagnosis sometimes doesn’t recognize a separate OCD pattern layered on top of it, particularly when the compulsions involved are mental rather than visible, like silently reviewing a memory or mentally repeating a phrase.
Anxiety treatment at Nassau Counseling Services accounts for this overlap directly, rather than treating OCD symptoms as general worry that responds to the same techniques as other anxiety presentations.
Get Started With Our OCD Therapists on Long Island
Many people live with OCD for years before starting treatment, often because they assume their specific thoughts are too unusual or too shameful to bring up, when in fact the categories above cover the large majority of what clinicians see in practice.
An initial appointment at Nassau Counseling Services starts with mapping out current symptoms and discussing whether ERP, cognitive therapy, ACT, or a combination with medication coordination fits a specific situation best. Contact Nassau Counseling Services to schedule an appointment and start working with a therapist trained in the treatment of OCD.